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MED as Part of a Medication Management Program

| Jul 20, 2015
As previously run in WorkCompWire

In the workers’ compensation industry, 60.2% of claimants utilize opioid analgesics for the treatment of pain caused by a workplace injury (Helios, 2015). But with the use of opioids also comes inherent risks, such as addiction, tolerance, dependence, misuse, abuse, and even death. Because of this, it is important to understand the potency of the medications being prescribed and when additional caution and monitoring is warranted. That is what the morphine equivalent dose (MED) helps provide.

What is an MED?

An MED is a numerical standard against which most opioids can be compared, yielding an apples-to-apples comparison of each medication’s potency. Although it’s easy to presume that 10 mg of medication A are equal to 10 mg of medication B, differences in how opioid medications work in the body prohibits this sort of comparison, thus the need for calculating the MED of each product. It is not about a medications efficacy or how well it works, but about its relative potency. Morphine is used as the basis for this comparison because it is considered the “gold standard” for the treatment of pain. Knowing the MED helps determine if the patient’s opioid doses are excessive and is useful if converting from one opioid to another.

How MEDs Are Used

Prior to 2007, there was no workers’ compensation definition for what constituted a high dose of opioids, until the Washington Department of Labor and Industries established guidelines. Their guidelines suggested that when an injured worker reached an oral MED of 120 mg, they undergo an evaluation by a pain specialist to determine if the treatment should be continued, the dose reduced, or if they should be weaned off of the medication.

Since then, in an effort to promote more rational prescribing of opioids for the treatment of occupational injuries, organizations such as the American College of Occupational and Environmental Medicine (ACOEM) and the Work Loss Data Institute (Official Disability Guidelines or ODG) have published guidelines for the use of opioid analgesics that clearly establish best practices with regard to the treatment of injury-related pain. Their guidelines specify an MED of 50 mg and 100 mg respectively.

The purpose of these guidelines is not to have every patient taking a certain level of MED or less, rather they provide guidance on when additional precautions may be necessary. The guidelines let providers know that when a patient is taking a certain level of opioid analgesics, there should be a value-based assessment to determine if the medication therapy is appropriate for the injured worker.

Calculating MED

To calculate MED, a standard conversion table can be used that sets an equivalent analgesic dose or equianalgesic dose for morphine. Once that is established, a multiplication factor can be used to calculate MED.

As an example, if an injured worker is prescribed 40 mg of OxyContin® to be taken twice daily, that’s a total of 80 mg per day. OxyContin is a form of oxycodone. For this example, the multiplication factor for oxycodone is 1.5, which means 1.5 mg of oxycodone equals 1 mg of morphine. If you multiple 80 mg by 1.5, you get a total MED of 120 mg, which exceeds recommended guidelines.

Prescription: 40 mg OxyContin x 2/day = 80 mg

OxyContin = oxycodone
1.5 mg oxycodone = 1 mg morphine

80 mg OxyContin x 1.5 = 120 mg MED

MED calculation can be a beneficial component to your medication management program, providing guidance on when additional vigilance maybe required, such as medication agreements or urine drug testing. For more information on MEDs, read our white paper, “Shining a Light on MEDs: Understanding Morphine Equivalent Dose.”

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